Hidden hunger — The unnecessary evil

Hidden hunger – though a very significant issue – is an unnecessary evil which at times goes unnoticed.

More than two billion people worldwide suffer from micro-nutrient deficiencies because they are not meeting their daily dietary requirements for essential vitamins and minerals.

These deficiencies not only affect an individual’s long-term health but can also raise societal and public health care costs and potentially depress a nation’s economic productivity.

Closer home, one-in-three children in Zimbabwe suffer from chronic malnutrition which results in the hampering of children’s growth and development.

It has been proven that poor infant and young child feeding practices, illnesses and poor maternal health result in malnutrition.

As if that is not enough, malnutrition increases the likelihood of non-communicable diseases in latter life, such as cancer, diabetes and cardio-vascular disease.

But many experts believe it could be greatly eased by a simple Government measure of mandatory food fortification.

Starting from July 1 this year, Government devised Statutory Instrument 120 of 2017 – Mandatory Food Fortification Programme – where food processing companies were compelled to add nutrients to everyday foods such as bread, mealie-meal, cooking oil and sugar to enrich consumers’ diet.

A nutritionist in the Ministry of Health and Child Care, Mr Dexter Chagwena, said micronutrient deficiency is a public health concern in Zimbabwe.

“This hidden hunger contributes to more than a third of deaths in children under five years per year and is also the main cause of productivity and earning potential losses,” he said.

While some companies are resisting the food fortification programme, more companies are complying with the directive.

Nestle communications and public affairs manager, Mr Farai Munetsi, said the company was already fortifying foods.

“As Nestle we believe in providing adequate nutrients, health and wellness of our customers hence fortification was always our priority,” he said.

Other companies already fortifying foods are Zimgold, Unifoods, National Foods and Tongaat Hulett, among others.

Food fortifcation involves replacing nutrients lost during food processing to increase nutritional value.

Health surveys indicate that there are several contributing factors that cause chronic malnutrition or stunting in children.

The Micro-nutrient Survey (2012) indicated that stunting stands at 30 percent, Vitamin A deficiency at 21 percent, iron deficiency at 72 percent and anaemia at 31 percent in children under five.

The appalling circumstances are that these deficiencies are more rampant in the rural areas as compared to urban areas. While most nutrition experts agree that a balanced and nutritious diet is the best way to obtain the much-needed nutrients, Zimbabweans have less than a perfect diet – long on calories and short on nutrients. However, millers and cooking oil producers have since rejected the programme citing unnecessary increase of production costs by a 10 percent margin. Government, on the other hand, reiterates that companies struggling to comply should apply for a waiver or risk being banned from producing.

Mr Chagwena added that food fortification is the cheaper and fastest way to curb malnutrition in any developing country.

“It costs less than $1 per year to protect an individual against deficiencies of the stated micro nutrients. And if you compare this with the cost of $9,87 one requires to manage a single vitamin or mineral deficiency per treatment cycle, you realise that food fortification is cheaper and necessary,” he added.

“It should be clarified to everyone that food fortification will not result in price hikes.”

A health expert who agreed to speak on anonymity explains that micro nutrient deficiencies result in increased morbidity, child and maternal mortality.

“Vitamin A deficiency results in blindness and increased childhood mortality, iron deficiency results in poor cognitive development and impacts future productivity while folic acid deficiency results in birth defects, disability and increased health care costs,” he said.

Although malnutrition rate in Zimbabwe is still lower than in other sub-Saharan countries it has increased over the past 15 years. According to Unicef, an estimated 161 105 children die before their fifth birthday.  The health expert added that malnutrition leads to a significant loss in human and economic potential.

“The performance of a country’s socio-economic sector is a reflection of the population’s nutritional well-being,” he said.

“Children who are malnourished are more vulnerable to infectious diseases that prolong their under nutrition and further hinder their full cognitive and behavioural development. As a result, undernourished children have reduced ability to learn and concentrate while in school, ending up with fewer opportunities to access jobs.

“In the end, the country suffers immense losses in productivity and incurs increased societal costs in education and health care.”

Malnutrition presents itself in three ways: stunting (shorter than average height), wasting (having a low weight for one’s height) and being underweight (having a low weight for one’s age).

The director for family health in the Ministry of Health and Child Care, Dr Bernard Madzima, applauded food fortification but bemoaned the lack of funding to see the success of the programme.

“The food fortification programme aims to address micro nutrient deficiencies which will help the country address the problem of malnutrition,” he said.

“Micro nutrients which are being added are Vitamin A, zinc, iodine, iron and folate. Though we have had a buy-in from major food producers, a huge challenge still remains in terms of funding as well as making small-scale millers comply.”

Dr Madzima added that if micro nutrient deficiencies are not addressed within the first two years of life, stunting is irreversible.

“Stunting does not come easy, it happens over time, and it means that a child would have endured a painful and unbearable cycles of illnesses, depressed appetite, insufficient food and inadequate care,” he said.

“This vicious cycle is itself a result of poverty and the consequent inability of families to adequately care for their children. A lack of clean water supply in a poor community, or a long distance between home and health clinic affects the level of care that can be given.”

Malnutrition is a condition that results from eating a diet in which nutrients are either not enough or are too much such that the diet causes health problems.

Moreover, exclusive breastfeeding remains a challenge in Zimbabwe resulting in a significant number of malnourished, stunted growths of children and high child mortality rate.

According to the Multiple Indicator Cluster Survey (MICS) 2014, only 41 percent of Zimbabwean women practice exclusive breastfeeding.

The major challenge to exclusive breastfeeding is that lactating mothers often mix breastfeeding with other foods and water during the first six months of a baby’s life.

Following recommendations by the Paediatric Association of Zimbabwe and other stakeholders like the World Health Organisation and Unicef, Government introduced micro-nutrient powders at the onset of 2015 for infants between the ages of six months and two years as a measure to curb malnutrition.

Micro-nutrient powders contain zinc, Vitamin A, iron and other relevant micronutrients and these will be mixed with porridge or soup and fed to the children as part of their diet.

Food fortification has already been used in salt and Zimbabwe no longer has problems of goitre since iodised salt was introduced.

Research shows that an estimated 25 percent of child deaths are attributable to nutritional deficiencies.

One of the first documented examples of food fortification was in the United States in the early 1900s where the authorities ordered niacin (Vitamin B3) to be added to corn to help combat the rise of pellagra and was highly effective.

Moreover, Government is committed to ensuring that the National Nutrition Strategy (2014-2018) is implemented on evidence-based nutrition interventions that are integrated within a broad public health framework including health services, water and sanitation.

Zimbabwe Vulnerability Assessment Committee (ZIMVAC) report indicates that 2,8 million people (30 percent of the rural population) of which 1,4 million are children urgently need food assistance.

Although the casual factors are many, malnutrition is one of the leading underlying causes of under-five deaths.

Government said it will continue providing micronutrient supplements to children and women.

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